Source: 49ers QB Purdy has torn UCL in elbow

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SANTA CLARA, Calif. — An offseason that already figured to have plenty of quarterback-centric questions for the San Francisco 49ers now has even more.

In the first quarter of Sunday’s NFC Championship Game, Niners rookie quarterback Brock Purdy suffered a torn ulnar collateral ligament in his right elbow that will keep him out for six months, a source told ESPN’s Adam Schefter on Monday. Based on that timeline, Purdy could return around the start of training camp or, perhaps, a couple of weeks into it.

Purdy is seeking additional medical opinions about whether he needs surgery, though the 49ers are recommending he has it, the source told Schefter.

The injury is expected to sideline Purdy for six months regardless of his decision on surgery, the source said.

The injury happened on the Niners’ sixth offensive snap in their 31-7 loss to the Philadelphia Eagles. After the game, the Niners believed Purdy was dealing with a sprained UCL but wanted to see what MRI results Monday morning turned up before offering a diagnosis.

“My arm felt like it stretched out,” Purdy said after the loss. “I felt really just like a lot of shocks all over from my elbow down to my wrist, front and back. Just pain really, all over.”

The decision regarding surgery for a torn UCL typically depends on several factors: the degree of the tear and whether it is complete, the presence of instability at the elbow and functionality (which, for a thrower, translates to whether he can throw effectively), according to ESPN injury analyst Stephania Bell. While regular daily activities might not require an intact UCL, a thrower requires stability at the elbow in order to not only throw effectively but do so repeatedly.

If UCL surgery is needed, it becomes a question of whether the athlete requires a full UCL reconstruction with a tendon graft, otherwise known as Tommy John surgery, or whether a surgical repair of the damaged ligament will suffice. The health of the ligament itself, the location of the tear and whether the injury is isolated to just the UCL further inform the decision.

In Purdy’s case, if the ligament is amenable to repair, he could undergo a surgical UCL repair augmented with an InternalBrace. The brace is a synthetic “check-rein” implanted alongside the repair to help reinforce the ligament as it heals. A repair is typically less invasive and would offer a shorter recovery time for Purdy. Whereas Tommy John surgery can require a year or longer to return to form, athletes in other sports are returning within six months from UCL repairs.

Tears of the UCL have been relatively uncommon in football, and given that surgical repair with InternalBrace is relatively new, there are not many comparisons when it comes to NFL quarterbacks.

However, the 49ers do have recent experience with a backup quarterback going through a similar injury. In 2020, Nick Mullens suffered a right elbow injury that many initially feared would require Tommy John surgery. But Mullens’ injury fit the criteria, and he became the first NFL quarterback to undergo a UCL repair with InternalBrace, a procedure that also enabled him to return to the field sooner than if he had required a full reconstruction.

Tommy John surgery is also fairly uncommon in football players, but there have been other quarterbacks to undergo the procedure in the past, including Jake Delhomme in 2007.

Purdy sustained the injury with 7:03 left in the opening quarter. On second-and-6 at the 50, he dropped back and prepared to fire a deep pass to receiver Brandon Aiyuk off play-action. But before Purdy could get the throw off, Eagles pass-rusher Haason Reddick blew past Niners tight end Tyler Kroft and hit Purdy just as he was about to throw.

The ball bounced off Purdy’s elbow and flew forward to Philadelphia’s 44. It was initially ruled an incomplete pass but overturned to a fumble on an Eagles challenge. While the play was being reviewed, Purdy was on San Francisco’s sideline attempting to figure out whether he was still able to throw.

Purdy said he tried to throw a few passes but immediately knew something was wrong when he couldn’t make any throws longer than 5 to 10 yards. He came out of the game but was later forced to return when backup Josh Johnson suffered a concussion.

Because of Purdy’s injury, he attempted just four passes, completing all of them for 23 yards.

“He went and kept throwing and realized he couldn’t, so there was really no discussion after that,” coach Kyle Shanahan said. “He couldn’t throw.”

With Purdy likely out for at least the offseason program, the 49ers again find themselves working through a quarterback dilemma that has been sparked by a series of injuries.

Trey Lance, who opened the season as the starter, is coming off a broken right ankle he suffered in Week 2 and expected to be ready to participate in the offseason program in some capacity, though the extent of that is unclear.

Jimmy Garoppolo, who broke his left foot in Week 13, is scheduled for unrestricted free agency, and the Niners cannot use a tag to keep him as part of the reworked one-year deal he signed in August.

Purdy and Lance are the only quarterbacks the Niners have under contract for next season as of Monday afternoon, which means they’ll need to add at least one more via free agency or the NFL draft to get through the offseason program.

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